Healthcare Provider Details

I. General information

NPI: 1679780159
Provider Name (Legal Business Name): NECOLE ELEASE WASHINGTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 MITCHELLVILLE RD SUITE 108
BOWIE MD
20716-1385
US

IV. Provider business mailing address

16525 GOVERNOR BRIDGE RD APT. 305
BOWIE MD
20716-3673
US

V. Phone/Fax

Practice location:
  • Phone: 301-218-0398
  • Fax: 301-218-0040
Mailing address:
  • Phone: 301-352-3451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License NumberD58377
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: